Kevin S & Tina S Watt

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

24027 Issued in CA

Legal business name

KEVIN S & TINA S WATT

Practice address

1110 W Kettleman LN
27
Lodi, CA 95240-6031

Phone

(209) 334-2366

Fax

(209) 334-2377

NPI assigned

Jul 14, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kevin S Watt, D.C.NPI 1295865095

Title

Chiropractor/Owner

Phone

(209) 334-2366

Specialties & licenses 1

Addresses

Other names 1

• Woodlake Chiropractic Center Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kevin S Watt, DC

  • Chiropractor
  • Lodi, CA
  • NPI 1295865095
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1436832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442534400000",
    "number": "1851775381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 W KETTLEMAN LN",
            "address_2": "27",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952406031",
            "telephone_number": "209-334-2366",
            "fax_number": "209-334-2377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 W KETTLEMAN LN",
            "address_2": "27",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952406031",
            "telephone_number": "209-334-2366",
            "fax_number": "209-334-2377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEVIN S & TINA S WATT",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-14",
        "last_updated": "2015-09-18",
        "status": "A",
        "authorized_official_last_name": "WATT",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CHIROPRACTOR/OWNER",
        "authorized_official_telephone_number": "209-334-2366",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "24027",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Woodlake Chiropractic Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Patricia Lynn Kennel, M.D.
• Clifford Dean Kerr, DDS
• Michael Ketelaar, M. D.
• Kevin L Fleming, DDS a Professional Corporation
• Kevin S & Tina S Watt
• Aman Khan
• Faatihah Khan
• Sabrina Begum Khan I
• Shakila B. Khan
• Zaman Khan, PHARM.D

• Chiropractor in Lodi, CA
• Providers in Lodi, CA by specialty
• Chiropractor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.